Alan Sipress - The Fatal Strain

109 flooded with the infirm:See, for example, Rob Stein, “Shortage of Flu Shots Prompts Rationing,” Washington Post, Dec. 9, 2003; Rob Stein, “24 States Hit Hard by Flu Outbreak,” Washington Post, Dec. 12, 2003; and Anita Manning and Tom Kenworthy, “Flu and Fear Run Rampant,” USA Today, Dec. 10, 2003.

109 give up their beds:“Influenza: Last Bad Flu Season Killed Nearly 65,000; Will This Season Be Worse?” Drug Week, Jan. 2, 2004.

109 made its first recorded appearance:Alfred W. Crosby, America’s Forgotten Pandemic: The Influenza of 1918, 2nd ed. (New York: Cambridge University Press, 2003), 71.

109 sailors transferred days earlier:John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (Viking Penguin: New York, 2004), 192.

110 Fourth Annual Liberty Loan parade: Philadelphia Inquirer, Sept. 29, 1918.

110 an old photograph: www.history.navy.mil/photos/images/h41000/h41730.jpg.

110 every hospital bed:Barry, Great Influenza, 220.

110 “When they got there”:Selma Epp, transcript of unaired interview for “Influenza 1918,” American Experience, Feb. 28, 1997, quoted in Barry.

110-11 “historic records of the plague”:Ellen C. Potter, letter to Miss M. Carey Thomas, Oct. 3, 1918, M. Carey Thomas Papers, Special Collections Department, Bryn Mawr College.

111 254 deaths in a single day:Barry, Great Influenza, 221.

111 daily toll was 759:Ibid., 329.

111 “none to replace them in the wards”:Francis Edward Tourscher, Work of the Sisters During the Epidemic of Influenza, October, 1918 (Philadelphia: American Catholic Historical Society, 1919), p. 18, accessed through Villanova University Digital Library Browser, reprinted from the Records of the American Catholic Historical Society of Philadelphia 30s, nos. 1-3 (Mar.-Sept. 1919).

111 Almost half the doctors and nurses:Barry, Great Influenza, 226.

111 “had no attention for over 18 hours”:Tourscher, Work of the Sisters, 18.

111 “After gasping for several hours”:Ira Starr, “Influenza in 1918: Recollections of the Epidemic in 1918,” Annals of Internal Medicine 145, no. 2 (July 18, 2006).

111 at the poorhouse:Tourscher, Work of the Sisters, 50.

112 the residence of a wealthy family:Ibid., 62.

112 cars bearing medical insignia:Starr, “Influenza in 1918.”

112 so they could help fill prescriptions:Eileen A. Lynch, “The Flu of 1918: It Started with a Cough in the Summer of 1918,” Pennsylvania Gazette, Nov. 1998.

112 Nearly 500 police officers: Philadelphia Inquirer, Oct. 20, 1918.

112 About 1,800 telephone employees:Barry, Great Influenza, 328.

112 “no other than absolutely necessary calls”: Philadelphia Inquirer, Oct. 18, 1918.

112 one Fishtown home:Tourscher, Work of the Sisters, 74.

112 During the second week:Great Britain Ministry of Health, Report on the Pandemic of Influenza 1918-1919 , Reports on Public Health and Medical Subjects no. 4 (London: His Majesty’s Stationery Office, 1920), 319-20, quoted in Crosby, America’s Forgotten Pandemic .

112 abandoned corpses were stacked:“Emergency Service of the Pennsylvania Council of National Defense in the Influenza Crisis,” 35, quoted in Crosby, America’s Forgotten Pandemic.

113 piling up on the porches:Harriet Ferrell, transcript of unaired interview for “Influenza 1918,” American Experience, Feb. 28, 1997, quoted in Barry, Great Influenza.

113 “The smell would just knock you”:Interview by Charles Handy for WHYY-FM program “The Influenza Pandemic of 1918: Philadelphia, 1918.”

113 “They were taking people out”:Ibid.

113 “They had so many died”:Ibid.

113 dispatched a steam shovel:“Emergency Service of the Pennsylvania Council of National Defense in the Influenza Crisis,” 35, quoted in Crosby, America’s Forgotten Pandemic; and the Philadelphia Inquirer, Oct. 12, 1918.

113 people were stealing them:Michael Donohue, transcript of unaired interview for “Influenza 1918,” American Experience, Feb. 28, 1997, quoted in Barry, Great Influenza.

113 under armed guard:Barry, Great Influenza, 327.

113 12,897 Philadelphians:Great Britain Ministry of Health, Report on the Pandemic , 319-320, quoted in Crosby, America’s Forgotten Pandemic.

113 “It was the fear and dread”:Tourscher, Work of the Sisters, 105.

114 tremendous financial pressure:One-third of hospitals were reported to be operating at a deficit. See John G. Bartlett and Luciano Borio, “The Current Status of Planning for Pandemic Influenza and Implications for Health Care Planning in the United States,” Clinical Infectious Diseases 46 (Mar. 15, 2008): 919-25.

114 Hospitals have been closing:Neil A. Halpern, Stephen M. Pastores, and Robert J. Greenstein, “Critical Care Medicine in the United States 1985-2000: An Analysis of Bed Numbers, Use, and Costs,” Critical Care Medicine 32, no. 6 (June 2004): 1254-59. Between 1993 and 2003, the United States saw a net loss of 703 hospitals, or 11 percent, and a decline in inpatient beds of 198,000 or 17 percent. See American Hospital Association figures cited in Institute of Medicine, Hospital-Based Emergency Care: At the Breaking Point (Washington: National Academies Press, 2007), 38. Sixty percent of U.S. hospitals reported in 2001 that they were operating at or over capacity. See the Lewin Group, Emergency Department Overload: A Growing Crisis, the results of the AHA Survey of Emergency Department (ED) and Hospital Capacity.

114 vacant ICU beds were rare:Lewis Rubinson et al., “Augmentation of Hospital Critical Care Capacity After Bioterrorist Attacks or Epidemics: Recommendations of the Working Group on Emergency Mass Critical Care,” Critical Care Medicine 33, no. 10 (2005): 2392-2403. In a severe pandemic, the demand for these ICU beds could outstrip capacity by nearly five times. See Eric Toner et al., “Hospital Preparedness for Pandemic Influenza,” Biosecurity and Bioterrorism 4, no. 2 (2006): 207-14. Even in a moderately severe outbreak, half the states would run out of hospital beds within two weeks. See Trust for America’s Health, Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, Dec. 2006.

114 a severe nursing shortage:See Elizabeth Daugherty, Richard Branson, and Lewis Rubinson, “Mass Casualty Respiratory Failure,” Current Opinion in Critical Care 13, no. 1 (Feb. 2007): 51-56; Derek C. Angus et al., “Current and Projected Workforce Requirements for Care of the Critically Ill and Patients with Pulmonary Disease,” Journal of the American Medical Association 284, no. 21 (Dec. 6, 2000): 2762-70; Mark A. Kelley et al., “The Critical Care Crisis in the United States: A Report from the Profession,” Chest 125 (2004): 1514-17; Gary W. Ewart et al., “The Critical Care Medicine Crisis: A Call for Federal Action,” white paper from the Critical Care Professional Societies, Chest 125 (2004): 1518-21; and J. K. Stechmiller, “The Nursing Shortage in Acute and Critical Settings,” AACN Clinical Issues 13, no. 4 (Nov. 2002): 577-84. The nationwide shortage of nurses has been estimated at between 100,000 and 291,000. All but ten states had a shortage of registered nurses in 2006. See John G. Bartlett and Luciano Borio, “The Current Status of Planning for Pandemic Influenza and Implications for Health Care Planning in the United States,” Clinical Infectious Diseases 46 (Mar. 15, 2008): 919-25; and Trust for America’s Health, Ready or Not? Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, Dec. 2006.