Vic Socotra

28 April 2009

In-Flew-Enza

I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza.
- Children’s Skipping Rhyme circa 1918, US

(Medical Mask)

One of the advantages of a Gypsy life is that you get to see a lot of things would normally observe if you actually worked for a living. There is a downside, of course, in that you never get particularly good at any one thing. But you are forced to develop a sort of universal skill set, appropriate to whatever situation your might find yourself.

I myself was very good at sitting behind increasingly larger desks, and nodding with apparent interest. But there were other skills, mostly useful in crisis. The last government job I had was never intended to be what it was; I was detailed over to the Hubert Humphrey Building to help the Assistant Secretary establish a better relationship with the Spooks.

It seemed that no one had considered precisely what sort of drugs ought to be in the National Pharmaceutical Stockpile based on the actual threat. The contents of the NPS were required to be no more than eight hours from any point in the US, if necessary. It is a neat capability with roots in the Cold War, but the connection to civil defense had become tenuous. The contents had been formulated from a public health basis, not based on what bin Laden might have been cultivating on those one-acre plots in Sudan. There needed to be a national security component to Public Health preparedness.

I did not have any particular expertise in public health, though as the man in the commercial said, if I dressed properly you would not know that. And so I found myself on the sixth floor in a brand spanking new Command Center supporting the Department of Health and Human Services as the lead agency for Emergency Support Function 8, Public Health and Medical Services.

We were supposed to provide the mechanism for coordinated Federal assistance to supplement State, tribal, and local resources in response to a public health and medical disaster requiring coordinated Federal response. We were the entry point for policy matters with the World Health Organization, and our primary operating agency was the Center of Disease Control down in Atlanta. The National Institutes for Health in Bethesda were a primary resource.

It was all quite impressive, and you can imagine how interested we were when the first reports came from Vietnam about the new disease that was killing all in its path.

The Department of Homeland Security was just being established, and you can imagine the chaos. The new bureaucracy was flexing its muscles, considering the possibility that everyone in government now reported to them. There was anthrax in the mail, and suspicious piles of white powder were being found everywhere.

I have to tell the story a little out of sequence, since we did not know the way things really happened until later. The first [public blip of the pandemic hit the radar in February of 2003, just as I was decorating my office at the Hubert Humphrey Building.

An American business traveler named Johnny Chen was traveling from Shanghai to Singapore, via Hong Kong. He stayed at the Metropole Hotel, on the ninth floor. It is a nice hotel, but it was an unlucky booking, since room 911 turned out to be the epicenter of the global outbreak.

Mr. Chen left Hong Kong for Singapore on a flight to Singapore that stopped at Hanoi. He displayed symptoms consistent with pneumonia on the airplane, and was removed from the airplane and transferred to the French Hospital there in town. Several of the medical staff who treated him soon developed the same disease. An Italian physician named Carlo Urbana identified the severity of the threat, and the rising panic at the hospital, and alerted the WHO.

Dr. Urbani died shortly thereafter.

When you consider that about a half million people are airborne on commercial jets, sealed up in aluminum tubes breathing each other’s air, it is enough to get your attention.

In short order, the acute pneumonia had a name- Severe Acute Respiratory Syndrome- and was identified in Thailand, Vietnam, Hong Kong, China and Taiwan. Based on the convenience of air travel, it was also in Toronto, and someone who had stayed on the ninth floor of the Metropole hotel had attended the annual stockholders meeting of the Coca-Cola Company in Atlanta, home of the CDC.

Things looked like they were spinning out of control, and people began to talk about the “Q”-word.

Forced Quarantine.

A public health method that had not been attempted seriously since the great Spanish Flu pandemic of 1918-19 that killed somewhere between fifty and a hundred million people. That is like the dead of the two great wars all rolled up in one.

Jeepers. What a time to get into the public health game, I thought.

Obey the laws
And wear the gauze.
Protect your jaws
From septic paws

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