Alan Sipress - The Fatal Strain

114 Emergency rooms are being shuttered:Eric W. Nawar, Richard W. Niska, and Jianmin Xu, “National Hospital Ambulatory Medical Care Survey: 2005 Emergency Department Summary,” advance data from Vital and Health Statistics, no. 386, June 29, 2007. For a comprehensive overview of the crisis facing U.S. emergency departments, see Institute of Medicine, Hospital-Based Emergency Care: At the Breaking Point (Washington: National Academies Press, 2007). According to figures from the American Hospital Association cited in the IOM report, the number of hospitals with emergency departments declined by 425 over the decade ending in 2003.

114 departments were routinely overcrowded:“State of Emergency Medicine: Emergency Physician Survey,” American College of Emergency Physicians, October 2003. Sixty-two percent of U.S. hospitals surveyed in 2001 said their emergency departments were operating at or over capacity. For large hospitals and those offering the most advanced trauma care, the percentage increased to about 90 percent. See the Lewin Group, Emergency Department Overload: A Growing Crisis, results of the AHA Survey of Emergency Department (ED) and Hospital Capacity, Apr. 2002. As the IOM writes, “In many cities, hospitals and trauma centers have problems dealing with a multiple-car highway crash, much less the volume of patients likely to result from a large-scale disaster.” Institute of Medicine, Hospital-Based Emergency Care, 265.

114 once every single minute:Catharine W. Burt, Linda F. McCaig, and Roberto H. Valverde, “Analysis of Ambulance Transports and Diversions Among U.S. Emergency Departments,” Annals of Emergency Medicine 47, no. 4 (2006): 317-26. See also Sally Phillips, “Current Status of Surge Research,” Academic Emergency Medicine 13 (2006): 1103-8.

114 hospital executives were too preoccupied:“Emergency Preparedness: States are Planning for Medical Surge, but Could Benefit from Shared Guidance for Allocating Scarce Medical Resources,” U.S. Government Accountability Office, June 2008.

114 decreased 18 percent:Ibid.

114 producers of medical oxygen:Michael D. Christian et al., “Definitive Care for the Critically Ill During a Disaster: Current Capabilities and Limitations,” Chest 133, no. 5 (May 2008): 8S-17S.

114 tremendous shortage of ventilators:Ibid.; and Isaac Weisfuse, “Summary Background on Hospital Pandemic Preparedness in NYC,” in Beth Maldin-Morgenthau et al., “Roundtable Discussion: Corporate Pandemic Preparedness,” Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science 5, no. 2 (2007): 171.

115 about 740,000 people would require ventilation:“States are Planning for Medical Surge,” U.S. Government Accountability Office, June 2008.

115 between 53,000 and 105,000:Michael T. Osterholm, “Preparing for the Next Pandemic,” NEJM 352, no. 18 (May 5, 2005): 1839-42; and Elizabeth Daugherty, Richard Branson, and Lewis Rubinson, “Mass Casualty Respiratory Failure,” Current Opinion in Critical Care 13, no. 1 (Feb. 2007): 51-56. A study by New York State found that even in a moderate pandemic, there would be a state-wide shortfall of 1,256 ventilators. In a severe pandemic, the total demand for ventilators in peak weeks would run to 17,844, almost three times the existing capacity. See NYS Working Group on Ventilator Allocation in an Influenza Pandemic, NYS DOH/NYS Task Force on Life and the Law, “Allocation of Ventilators in an Influenza Pandemic: Planning Document,” Mar. 15, 2007.

115 the Spanish flu’s victims:David M. Morens, Jeffrey K. Taubenberger, and Anthony S. Fauci, “Predominant Role of Bacterial Pneumonia as a Cause of Death in Pandemic Influenza: Implications for Pandemic Influenza Preparedness,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 962-70; Jonathan A. McCullers, “Planning for an Influenza Pandemic: Thinking Beyond the Virus,” Journal of Infectious Diseases 198, no. 7 (Oct. 1, 2008): 945-47; and John F. Brundage and G. Dennis Shanks, “Deaths from Bacterial Pneumonia During 1918-1919 Influenza Pandemic,” Emerging Infectious Diseases 14, no. 8 (Aug. 2008): 1193-99.

115 80 percent of all prescription drugs:Michael T. Osterholm, “Unprepared for a Pandemic,” Foreign Affairs , Mar.-Apr. 2007.

115 “interconnectedness of the global economy”:Ibid.

116 would run short on everything:Michael T. Osterholm, “Preparing for the Next Pandemic,” Foreign Affairs, July-Aug. 2005.

116 an unpublicized conference call:Personal notes of conference call, Jan. 15, 2004.

116 an article for Science: Richard J. Webby and Robert G. Webster, “Are We Ready for Pandemic Influenza?” Science 302, no. 5650 (Nov. 28, 2003): 1519-22. Webster also raised concerns in 2003 in Robert G. Webster and Elizabeth Jane Walker, “Influenza,” American Scientist 91, no. 2 (Mar.-Apr. 2003): 122.

116 “Klaus was very excited”:Interview with Dick Thompson.

117 “Hitoshi suddenly came alive again”:Interview with Peter Cordingley.

118 The cases continued to come:WHO: “Preliminary Clinical and Epidemiological Description of Influenza A (H5N1) in Vietnam,” Feb. 12, 2004; Tran Tinh Hien et al., “Avian Influenza A (H5N1) in 10 Patients in Vietnam,” NEJM 350, no. 12 (Mar. 18, 2004): 1179-88; and Pham Ngoc Dinh et al., “Risk Factors for Human Infection with Avian Influenza A H5N1, Vietnam 2004,” Emerging Infectious Diseases 12, no. 12 (Dec. 2006): 1841-47.

118 Thailand finally stopped:For an overview of cases in both Thailand and Vietnam, see “Avian Influenza A (H5N1),” Weekly Epidemiological Record 79, no. 7 (Feb. 13, 2004): 65-76. On Thailand specifically, see “Cases of Influenza A (H5N1)—Thailand 2004,” Morbidity and Mortality Weekly Report 53, no. 5 (Feb. 13, 2004): 100-103; Darin Areechokchia et al., “Investigation of Avian Influenza (H5N1) Outbreak in Humans—Thailand, 2004,” Morbidity and Mortality Weekly Report 55, suppl. 1 (Apr. 28, 2006): 3-6; and Anucha Apisarnthanarak et al., “Atypical Avian Influenza (H5N1),” Emerging Infectious Diseases 10, no. 7 (July 2004): 1321-24.

122 release the findings:WHO, “Avian Influenza A (H5N1)—Update 14: Two Additional Human Cases of H5N1 Infection Laboratory Confirmed in Vietnam, Investigation of a Family Cluster,” Feb. 1, 2004.

123 “the ethics of researchers”:“Thaksin Challenges WHO Statement,” Nation (Thailand), Feb. 3, 2004.

123 “temperatures were running high”:Nguyen Tran Hien, Jeremy Farrar, and Peter Horby, “Person-to-Person Transmission of Influenza A (H5N1),” Lancet 371, no. 9622 (Apr. 26, 2008): 1392-94.

125 “think of it like a war”:Notes of WHO teleconference, Feb. 7, 2004.

125 widespread in ducks:Y. Guan et al., “H5N1 Influenza: A Protean Pandemic Threat,” PNAS 101, no. 21 (May 25, 2004): 8156-61.

125 permanent foothold in Asian poultry:K. S. Li et al., “Genesis of a Highly Pathogenic and Potentially Pandemic H5N1 Influenza Virus in Eastern Asia,” Nature 430 (July 8, 2004): 209-13.

126 “no link could be established”:Internal WHO report, undated.

126 “almost certainly H2H transmission”:E-mail, Nov. 6, 2004.