Humbug Square - Pest house memories

Think Katrina was bad? Try an avian flu pandemic

My mother was born at home on Walker Street in what is now called the Castleberry Hill neighborhood. That was the spring of 1918.</
By fall, she and her mother were forced to move into a “pest house.” They were quarantined in a building that was right out of a Charles Dickens novel, a place to which people suffering from contagious diseases were banished.</
Around the same time, in October of 1918, influenza swept through America like a storm. The flu pandemic killed more people worldwide in 24 weeks than AIDS has killed in 24 years. Death toll estimates range from 50 million to 100 million. Up to 10 percent of all young adults in the world may have perished.</
On Oct. 7, 1918, as the pandemic swept into Atlanta, City Council declared all public gathering places — including schools, libraries, churches and theaters — closed for two months, according to a chronology on the Carl Vinson Institute of Government’s web page. The University of Georgia indefinitely suspended classes. People wore gauze masks. And some victims were forced into pest houses.</
Mama and her mother didn’t have influenza. They had smallpox. Mama showed me the pockmarks on her face. When I was a kid, I didn’t have one of those little dime-sized smallpox vaccination scars on my arm like my friends. I inherited an immunity to the disease, Mama said.</
Then she told me, “Don’t ever tell anybody I was in a pest house.” Of course, I’ve been telling people ever since. Writers make awful children.</
We don’t have pest houses anymore. People don’t even know what they were. But if health officials are correct in worrying about a new flu pandemic, we may all become familiar with them again. Maybe, some of us will even get to visit one for a while.</
Remember the lack of flu vaccine last year? That was just regular old flu, not the killer virus, H5N1, rising out of the poultry flocks of Asia.</
Just last week, scientists reported that the 1918 flu was similar to H5N1. It crossed from flocks to folks on a parallel path with some of the same types of mutations.</
The Senate hurriedly passed a $3.9 billion appropriation for flu preparations, and Democrats sent a letter to President Bush expressing “grave concern that the nation is dangerously unprepared for the serious threat of avian influenza.”</
Then, the New York Times got its hands on the Bush administration’s draft plan for dealing with a flu pandemic. The plan had secretively and slowly been making its way through the federal bureaucracy. On Oct. 9, the Times reported that the plan “shows that the country is woefully unprepared, and it warns that a severe pandemic will kill millions, overwhelm hospitals and disrupt much of the nation.”</
Timing is everything, which is what worries me about John M. Barry’s book. His earlier book, Rising Tide: The Great Mississippi Flood of 1927 and How It Changed America not only was the best nonfiction book I’ve ever read, but it also was a “coming attractions” for the Hurricane Katrina disaster.</
His most recent book, The Great Influenza: The Epic Story of the Deadliest Plague in History, came out before politicians in Washington began to wake up to the terrifying realization that a flu pandemic in America could wipe out a third of the population.</
I asked Barry if the flu book would prove as prescient as Rising Tide.</
“I hope not,” he said. Barry is a New Orleans native who was frequently interviewed by national news outlets during Katrina and in her aftermath. As the floodwaters rose in his hometown, he saw many similarities between 1927 and 2005.</
“There were too many echoes,” he said. “It was pretty disturbing to me, frankly.” What was most disturbing was that in 1927, then-Secretary of Commerce Herbert Hoover handled the relief efforts much better than the federal government did this year. “Hoover did do a great job in rescuing and getting food and water and housing to 650,000 people. He managed to put together a rescue fleet in less time than it took [former FEMA Director] Michael Brown to get to New Orleans.”</
New Orleans had been shouting that the federal flood control policy was a disaster waiting to happen. “It was true in 1927, and it was true prior to Katrina,” Barry said.</
I asked if we have ignored similar warnings about a flu pandemic.</
“We have rather stupidly not taken influenza seriously over time,” he said. “Very little basic research has been done. There will be another pandemic. It’s the nature of the virus. The chief determinant of how bad that pandemic is going to be is up to the virus itself, not our preparations.”</
Both Barry and I ended up in hospital emergency rooms earlier this year with the flu. Barry was on a book tour in Kansas City, where most of the hospitals closed their emergency rooms because they were overwhelmed with influenza.</
“And this wasn’t a particularly bad year, despite the vaccine debacle of about a year ago,” he said.</
A flu pandemic of the kind that sweeps the world about three times a century would totally overwhelm our health system. “In fact, we are more vulnerable to influenza now than in the past,” Barry said. “We’ve got more elderly people and more people with impaired immune systems, such as cancer survivors.”</
Katrina taught us that our infrastructure can easily be overwhelmed by disaster. In Atlanta, an avian flu epidemic immediately would overrun our hospital system. The fact is, the system can barely handle the load on a good day.</
Dr. Art Kellermann, an Emory professor and Grady Memorial Hospital emergency room physician, says Atlanta hospitals are so crowded, they routinely have to divert ambulances to other hospitals, which may be overcrowded themselves. “Within the last two weeks, 12 of Atlanta’s major hospitals have been on one level or another of ambulance diversion,” he said.</
After Katrina, 300 inpatients were flown into Atlanta from the storm zone. They were placed in local hospitals, which were swamped. “The problem was that locals didn’t stop having heart attacks, strokes and car wrecks,” Kellermann said.</
“A 1918-style pandemic of avian flu would make Hurricane Katrina look like a rainy day,” he said. “The magnitude of that would be the biological equivalent of a widespread nuclear attack.”</
Even without a flu epidemic, health care professionals are trying to warn Congress and the media that hospitals are splitting at the seams. Kellerman joined 4,000 other emergency room physicians, nurses and EMTs in a demonstration in Washington on Sept. 27 to bring attention to the crisis of overcrowding in American hospitals. They got no coverage at all in the Washington Post, New York Times or USA Today.</
“Nobody is focusing on it,” Kellermann said. “They’re not focusing on the fact that an individual in America with private insurance and great health care coverage may not be able to get into the hospital of their choice because it’s diverting ambulances to another hospital, which is diverting ambulances to another hospital. This is now routine in the U.S.”</
But the hospital crisis will be almost moot in the case of a full-blown pandemic, and right now nothing stands in its way. Pharmaceutical companies are working on a vaccine for H5N1 avian influenza, but it’s not ready yet. Stocks of the popular medicine Tamiflu are running low.</
Gauze masks and pest houses anyone?</
Senior Editor Doug Monroe hopes to boost his immune system with CoQ10 this winter. You can reach him at