Lee tried to stifle a sneeze but couldn’t. Invisible to the naked eye, a cloud of almost five thousand virus-filled droplets launched into the air at some 150 km/ hour or roughly 100 mph. Some passengers in the wide-body Airbus frowned. The Hong Kong to London flight was long and no one wanted to catch a cold.

Lee planned to fill every waking moment of his stay in London. A concert at the Millennium Dome, dinners at some of the finest hotels, shopping in crowded malls — “What a chance,” Lee thought. All he had to concentrate on was a few hours in front of the International Board. It was his job to present sales trends in China to the bosses who were also winging it towards Heathrow, one of the world’s busiest airports. “The global executives will get only good news from me,” figured Lee. “Pity I don’t feel better …”

The Diagnosis

Lee was exhausted. He had a cough, scratchy throat, runny nose and muscle aches. A fever started but it wasn’t until Lee began having difficulties breathing that he decided to get help.

Doctors huddled in subdued discussion. Experts were rushed in. It was finally determined that Lee’s body was fighting strenuously against two viruses. Lee had caught a highly infectious Influenza A virus — a flu bug. However, at much the same time he had also picked up a second virus called H5N1. The two viruses had mixed their genes and formed a hybrid. Since this was now a radically new pathogen, Lee had no immunity to it.

Lee was not the only one in this fight. Infected passengers from Lee’s plane from Hong Kong had connecting flights to major cities in most continents. The global executives Lee had addressed at the office had also flown home diseased. Sadly, some of the medical staff where Lee was diagnosed had also caught it not to mention the crowds Lee had interacted with at concerts, restaurants and on shopping sprees. The so-called Bird Flu or Avian Influenza had indeed spread its wings. It was the start of the first flu pandemic of the 21st century.

The News

Had Lee or any of the others known in time, they would have taken anti-viral drugs hoping to block or at least slow down the replication of the virus. At least the severity of some symptoms might have been eased not to mention a reduction in the duration of sickness. But time had run out – anti-viral medication needed to be taken within 48 hours of the first stages of the disease.

It wasn’t long before Lee was put on a respirator in quarantine. It also wasn’t long before the media found out Lee had Bird Flu. The public became nervous. The number of flu patients — real or imaginary — multiplied dramatically but nurses and hospital staff were strangely missing … using overdue holiday time or just not showing up for work at all. It was announced that schools, restaurants, and non-essential businesses would be closed. No deadline was given — no one knew for sure how long the measures would have to be in place.

The Public Announcement

Wisely, the public was advised to stock up on food and water. Newspapers advised people to stock up on toothpaste, toilet paper and treasure (cash). People were told to shop at off-peak hours and public transport was ordered to run 24 hours per day. But despite warnings to the contrary, doctor’s offices, hospitals and clinics were overrun. Faces masked in paper waited for hours in front of pharmacies in hope of getting relief. Despite clear instructions from health officials, panic broke out as folk finally fathomed that at best only one third of the population had access to anti-viral drugs. In rural areas and smaller towns, there wasn’t any chance at all.

The Short-term Havoc

Rumors and half-truths began to circulate causing public outcry and protests. Because the protests only helped spread the flu, quarantines were set in place. The public was told to stay at home indefinitely. Vibrant cities screeched to a halt as public transport shut down. Streets stank as garbage piled up. Shops were looted and in some cases those caught coughing were stoned. Safety services (fire, police, ambulance) were disrupted, fires burned out of control. Cross-border travel was curtailed killing tourism and all international sports events were cancelled. Food imports were banned creating shortages of meat, vegetables and wheat. Folk with chronic medical illnesses couldn’t get their medications. Soap and disinfectants — perhaps the simplest and most effective fight against the spread of disease — were in short supply; no one had thought to stock-pile soap.

The Controversy

Local governments and health organizations began to squabble over who had the power to do what. The question was of legalities: who would control distribution of anti-viral drugs and who would receive those drugs? Army barracks received attention but prisoners were ignored. Families with pets were labeled as ‘higher risk’ groups but no-one knew if these families should receive more help or less. As in-fighting became more severe, decision processing became more difficult. Who should give the daily press briefings? Who would organize mass cremation? Who would facilitate conferences for global medical meetings? The list grew rapidly.

The Waves

The first wave of the pandemic was over in three months time but not the shock. Bacterial disease such as cholera multiplied rapidly with catastrophic results across Africa and Asia. The longer-term, global recession began with the realization that supply-lines, manufacturing and food-production chains were desperately weakened through labor loss. Medical facilities were terribly understaffed. As usual, the poor had little chance of aid at all. And then came the second wave of Avian flu. It took over a year before the waves of sickness and death became controllable.

Lee actually survived it all. Although he “started” the pandemic, he also helped “end” it. Doctors used his blood to find the initial vaccine. Since Lee was also now immune, he not only volunteered to help where he could and also founded the World Association of Sensible Hygiene (WASH). More importantly, Lee and others like him helped disrupted societies regain their faith and hope and love. Since this was pandemic number 11 in the last 300 years, history had taught that it was inevitable that individuals and communities and countries would bounce back fairly quickly. But a bitter question remained. Would Lee and the rest of the world be better prepared for the next pandemic? Lee wondered that too as he bordered the wide-body Airbus destined for Mexico City.

A government report says an outbreak could kill 2 million people and lead to quarantines, travel restrictions and an economic downturn.

The White House on Wednesday unveiled a foreboding report on the nation’s lack of preparedness for a bird flu pandemic, warning that such an outbreak could kill as many as 2 million people and deal a war-like blow to the country’s economic and social fabric. It urged state and local governments to make their own preparations beyond the federal efforts.

In the government’s first detailed look at the potential effects on public health and U.S. society as a whole, the report said a full-blown pandemic could lead to travel restrictions, mandatory quarantines, massive absenteeism, an economic slowdown “and civil disturbances and breakdowns in public order.”

It warned that the healthcare system – including doctors, nurses and suppliers of pharmaceuticals – was inadequate to meet the country’s needs in a flu pandemic. “In the event of multiple simultaneous outbreaks, there may be insufficient medical resources or personnel to augment local capabilities,” the report warned.

More broadly, state, local and tribal governments should “anticipate that all sources of external aid may be compromised during a pandemic,” it said, meaning that “local communities will have to address the medical and non-medical effects of the pandemic with available resources.”

While warning that as a last resort, mandatory travel restrictions may be necessary, such limits alone “are unlikely to reduce the total number of people who become ill or the impact the pandemic will have on any one community.”

Some observers welcomed the report’s blunt tone.

Michael Osterholm, an expert on disease control who has long warned that the nation is ill-prepared for a bird flu pandemic, praised the 234-page report as “a very important step forward.”

“This was a brutally honest but very fair … assessment of where we’re at,” Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said in a telephone interview. He said he had no role in preparing the report.

The document includes the White House Homeland Security Council’s plan to implement a national strategy in the face of a flu pandemic, for which Congress appropriated $3.8 billion in December.

The strategy is built around three elements: preparation, surveillance and detection, and containment. And the report listed more than 300 steps that it said the administration would take, had already begun to take, or would recommend that state and local governments pursue.

In a cover letter, President Bush said the government had made “major investments in vaccine and antiviral development, research into the influenza virus, surveillance for disease in animals and humans, and the local, state and federal infrastructure necessary to respond to a pandemic.”

But the report indicated that only a bare beginning had been made thus far on preparing for the kind of large-scale, months-long disaster a flu pandemic would represent.

And critics were quick to attack what they said was the administration’s slow response.

As Frances Fragos Townsend, the president’s domestic security advisor, presented the report, Sen. Edward M. Kennedy of Massachusetts, the senior Democrat on the Senate Health Committee, issued a report of his own that chastised the administration for what it said was a failure to prepare the country for a flu pandemic.

Speaking on the Senate floor, Kennedy said the administration suffered from “competence-deficit disorder,” and said the White House report represented the third attempt to write a flu plan.

“No amount of revision can disguise the fact that other nations have been implementing their plans for years, while we are waiting to read ours for the first time today,” Kennedy said. “The United States is at the back of the line in ordering essential flu medicines, and we’re at the bottom of the international league in having a coordinated national strategy.”

There have been no verified incidences of bird flu in either wild birds or domestic poultry in North America, and spread of the disease from human to human has not been documented.

But, the report said, scientists believe birds played a role in two global influenza pandemics in the last 50 years that killed millions of people. It said that since the influenza strain known as H5N1 appeared in humans in Hong Kong in 1997, it has spread across Asia and into Africa and Europe and has infected more than 200 people, killing more than 50% of them.

For the Bush administration, the report represents an opportunity to demonstrate an effort to prepare for a potential catastrophe after the criticism it suffered for its response to Hurricane Katrina at the start of its second term, and, four years earlier, the intelligence failures that were blamed for not securing the nation against the Sept. 11 attacks.

Looking at specific demands that a pandemic would impose on the nation, the report said that workplace absenteeism could reach 40%.

To illustrate what the effect of such high levels of absenteeism could mean, Osterholm said that the oil industry had reported in one preparedness seminar that its refineries could not function if 30% of workers were absent – a figure suggesting that a pandemic could have a domino effect across the economy.

Although praising the study for “educating the government and hopefully the public that the pandemic is not just a health emergency,” Kim Elliott, deputy director of the health policy nonprofit Trust for America’s Health, said it failed to address the cost of implementing it.

She said Congress’ appropriation covered barely half of the $7.1 billion that Bush said last year would be needed.

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