Alan Sipress - The Fatal Strain

Then swine flu broke out. Researchers initially concluded it was spreading as vigorously as each of the three last pandemic strains. But soon it seemed the attack rate was no greater than that for ordinary flu bugs. Still, the epidemic’s ultimate course remained uncharted. Public health officials once more were making fateful decisions, whether, for instance, to embark on a crash vaccine program amid scientific uncertainty. Like all flu viruses, especially those so new to us, swine flu remained unpredictable. Its message, however, was unmistakable. Again, get ready.

Though governments have recently taken steps to gird the world for a pandemic, too little has been done. As I write, epidemic planning for hospitals and public health systems remains wanting. Preparations in other essential sectors, in particular those to ensure supplies of food, water, electricity, and fuel and to maintain public order, are even more deficient.

It’s surprising how few people know the horrors of 1918. Perhaps that cataclysm is overshadowed in memory by the final months of World War I, a conflict that recast the geopolitics of the world and defined a generation. Perhaps epidemics exist outside of history, ideology, and meaning, and their imprint vanishes like footsteps on the beach, especially when people have no one to blame for their tragedy, no grievance to harbor. It could be that people simply want to forget suffering. Or maybe we believe, as an advanced civilization, we’ve moved beyond plagues. By that reasoning, 1918 belongs to another, remote era of little relevance to today.

After I started this book, I told friends and colleagues what I was writing. The response wasn’t what I expected. Time after time, they would mention relatives who had died during the Spanish flu, a grandfather’s brother, a distant cousin. My architect told me his uncle and two other kin are buried in Jamaica after perishing in 1918. Then, several months before I finished the first draft, I discovered evidence of another visitation.

Growing up, I’d heard the story about how my grandmother’s mother, Yetta, had died as a young woman back in Poland. No one seemed to know precisely when, and no one ever mentioned the word influenza . We never connected it to anything else going on in the world at the time. All we knew was that she had been killed by some respiratory disease, maybe tuberculosis, maybe what they called grippe back then.

My grandmother, we heard, was eight at the time. It turned her life upside down. Soon after, Grandma’s father abandoned the family, leaving her to care for her younger sister and brother. They drifted from place to place, sleeping one night here, another there. Grandma found odd jobs to feed them, even working for a time picking fruit in orchards around Warsaw. Ultimately, her two maternal uncles sent for the children. The pair had earlier immigrated to New York, where one became a political pamphleteer and the other, according to family lore, hosted the longest continuously running pinochle game in the Bronx. Grandma left her homeland and crossed the ocean.

We’d never done the math to determine what year great-grandmother Yetta died. We couldn’t, because we didn’t know when Grandma was born. Grandma had lied on her American immigration papers to pass for a few years older so she could line up work. Over the rest of her life, the birth date on her government papers was fiction. When she finally passed away in 2006, she herself wasn’t sure how old she was. But my mother later came across Grandma’s marriage contract in an old file. On the back of this crumbling religious document, the date of the wedding was noted in pencil. With that clue, we could calculate Grandma’s birth date. She had been born in 1910. It meant Yetta had died, and our history pivoted, eight years later in 1918.

The timing wasn’t absolute proof that flu had been the killer. But the odds were overwhelming. The last great epidemic suddenly felt much closer. So did the next.

One of the secrets of foreign correspondence is how indebted we are to our local assistants. They translate not only language, when necessary, but culture. They help us conceive our stories, arrange logistics, navigate politics, identify the sources and subjects to interview, and, after all that, do old-fashioned reporting, sometimes at great personal risk, with rarely a byline to show for it. So the initial thanks have to go to Yayu Yuniar, a dogged, delightful journalist in Jakarta. Long before Indonesia confirmed its first human case of bird flu, Yayu dove into the basics of microbiology and went out chasing chickens with me. I’m also tremendously grateful to Lilian, Ira, and Sindi Pramudita, who did so much more than manage our office and local affairs in Indonesia. They became our second family. Noor Huda Ismail and Natasha Tampubolon rounded out our team in Jakarta. I also benefited from the hard work, generosity, and insights of local reporters and fixers elsewhere in Asia, in particular Somporn Panyastianpong in Bangkok, Phann Ana in Phnom Penh, K. C. Ng in Hong Kong, and Ling Jin in Beijing. Back in Washington, Jean Hwang was a tireless assistant, working into the wee hours transcribing often inaudible tapes.

The Washington Post has always been a special place. Yet with each passing year, as other newspapers succumb to the financial pressures of our troubled industry, the Post ’s commitment to great journalism becomes ever more exceptional. That dedication has flowed from the top, from Donald E. Graham, Boisfeuillet Jones Jr., and now Katharine Weymouth. For the opportunity to report from Southeast Asia, I’m grateful to former executive editor Leonard Downie Jr. and former managing editor Steve Coll, as well as to Philip Bennett, who was assistant managing editor for foreign news when I shipped out to Asia and managing editor when I returned. On the foreign desk, a string of talented editors had a hand in my writing about flu, including David Hoffman, Peter Eisner, John Burgess, Kathryn Tolbert, Tiffany Harness, and Jason Ukman. Thanks also to Nils Bruzelius, the deputy national editor for science and health, and news researchers Bob Lyford and Rob Thomason for their help.

The fraternity of flu writers is surprisingly small, given the drama and stakes of the subject. Yet in recent years I’ve been fortunate to count myself in the company of some terrific journalists. I’ve benefited from the work in Asia of Margie Mason of the Associated Press and Nicholas Zamiska of the Wall Street Journal . Closer to home, the standard has been set by Helen Branswell of the Canadian Press, Maggie Fox of Reuters, and Maryn McKenna, formerly of the Atlanta Journal-Constitution . In Jakarta, I was blessed with colleagues who were both good friends and reliable road companions at the toughest of times, in particular Rick Paddock of the Los Angeles Times , Shawn Donnan of the Financial Times , and John Aglionby of the Guardian and later the Financial Times . A special note of gratitude goes to Dean Yates of Reuters and to Mary Binks.

This would have been a very different book if not for the cooperation of countless individuals at the World Health Organization. I cannot name them all, and a fair number wouldn’t want me to. But I would like to acknowledge several members of the agency’s public affairs staff, past and present, including Maria Cheng, Peter Cordingley, Bob Dietz, Sari Setiogi, and Roy Wadia. Both in reporting for the Post and in researching this book, I found them consistently helpful. Mary Kay Kindhauser’s efforts in facilitating my reporting in Geneva were invaluable. And I’m particularly grateful to Dick Thompson and Kris tin Thompson for their professional assistance and personal kindness. There were also many at other agencies who took time to share their expertise and give me crash tutorials, including at the UN Food and Agriculture Organization, the World Animal Health Organization, and the Centers for Disease Control and Prevention. Nor can I say enough about the helpful staff of the U.S. National Library of Medicine or the team at the University of Minnesota that maintains the awesomely comprehensive Center for Infectious Disease Research and Policy (CIDRAP) Web site, www.cidrap.umn.edu.