THE THIN WHITE LINE: the history of a future avian influenza pandemic

Chapter 3: Pandemic

The Great Panic

    As the epidemic claimed more victims, dominated news coverage and presented a threat that grew closer to home for Canadians, it’s easy to understand how the Great Panic started in the second week of November with its attendant social disruption and violence. Consider a poll of Canadians taken at the beginning of the second week of the epidemic: Sixty percent said they saw bird flu as not a threat to them, and nearly 30 percent said the government exaggerated the threat.(47) At the time, many people considered it an exciting story on the news at best and an irritating disruption of their normal lives at worst. They still had to go to work, pay their bills, go shopping, manage their daily lives. By the fourth week, however, few remained in denial. By then, the epidemic dominated everybody’s lives and thoughts, even their nightmares, and led to the Great Panic with its rioting and looting.(48)
    Consider the situation of an average individual at this time, a Canadian suddenly awakening to the realities of the Pandemic.
    Bill Carpenter and Josee Trudel-Carpenter live in Montreal. Bill worked for an airline and Josee worked in a retail store. By mid November, both had lost their jobs when the travel and tourism industries collapsed and the government of Quebec, more aggressive than other provinces with its intervention strategies, closed many retail businesses. They have two children, ages six and eight, at home since the schools closed weeks earlier. They have no income and little savings.
Josee has taken the car out. It takes her a half-hour’s drive to find an ATM stocked with cash, using up precious gas, only to find out the bank is now limiting withdrawals. Meanwhile, the prices of everything from gas to breakfast cereal are skyrocketing. Voices on the car radio are counting the dead, pleading for essential workers to report to work; Josee finds that strange and wishes she had become a nurse and could be working right now and helping to support her family.(49) She adjusts the dial on her radio and finds a religious station, listens in on callers complaining about the government closing down the churches. A preacher comes on and says it’s the Apocalypse, the end of the world.
    As she drives to the supermarket, she sees a woman collapse on the sidewalk, sees people scattering to get away from her.
    At home, Bill is trying to call the bank to negotiate delayed payment of their mortgage, but the phones lines are jammed with callers; he can’t get through. He’s worried about credit——his credit card company has just issued new credit restrictions——and upset because he was late to remember to check their retirement accounts, and found out that much of their retirement savings evaporated when the stock market took a series of dives. In the living room, the kids are screaming at each other; they’re bored and want to go outside, but Bill won’t let them.(50) He turns on the TV and watches images of protest and mass cremation in China, Canadian military units boarding planes in far-off lands headed for home, an economist talking about layoffs and major bankruptcies. He finds out that outbreaks are being reported in South America, Europe and the Middle East. Then the news cuts out as a commercial appears, an ad from the government saying if you are caring for a sick family member in your home, stay at home yourself.
    Bill wants to turn off the TV but finds he can’t. He sits in a trance, the hours passing by, feeling numb, hopeless and unable to care for and protect his family.

People felt deeply terrorized by the flu, but they were afraid for different reasons. Some were afraid of dying. Some were afraid of their loved ones dying. Some were afraid they were all going to die and it was the end of the world. They were afraid in different ways. Some experienced long periods of strength followed by long moments of depression. Some withdrew into themselves and could barely get out of bed. Some became irrational, hysterical, and wanted somebody to blame. Some lived in complete denial. Some could think of nothing else. Some committed suicide. Some searched for solace in drugs or sex. Some thought only of their own survival. Some helped others in need.
Fear bred desperation. Before H5N1 arrived, people were often skeptical about flu vaccines. The elderly had to get them but many healthy adults ignored them. Now everybody wanted them even if they were useless as a prophylaxis against Avian Flu. People swilled flu remedies, antibiotics, zinc, Vitamin C, aspirin, multivitamins and herbal pills in an effort to fortify their bodies——their “Alamos,” as they came to be called during the epidemic——against the virus. Some bought up everything they can find on the Internet and black market, even though many of these drugs were simply dressed-up children’s aspirin. Some experimented with wild remedies, anything that promised immunity. They put hydrogen peroxide in their ears, drank cod liver oil in orange juice and wine vinegar, ate compressed yeast, wore necklaces of garlic.(51)

Rioters in Toronto throw rocks at a line of riot police. As new flu cases skyrocketed, economic growth stumbled, goods became increasingly scarce and the government banned public gatherings, people lost faith in government and the future, resulting in the Great Panic of November 8-15 with its looting and disruption.(52)

The constant fear bred an obsessive need for information. People watched the news and read Internet sites continuously, feeding on rumors: The government has a new vaccine. The Americans have a vaccine, but won’t share it. The Americans created the flu in the first place.(53) Taking your elderly parents to the nearest hospital and dumping them is their best shot at survival. Tamiflu is losing its effectiveness. A guy with a van behind London Drug is selling N95 masks and surgeon’s gloves. Grocery stores are demanding payment in gold. Child tax credit checks aren’t being issued due to a computer foul-up. The flu got into a prison and inmates and guards alike are dropping like flies. The farmers sealed off their communities and are shooting trespassers on site, including RCMP officers. The police machine-gunned rioters in Vancouver. Some flu survivors have brain damage and walk around like zombies. Martial law has been declared in Florida under the Emergency Powers Health Act. Japan’s Coast Guard is sinking Korean refugee boats off its coast. Mass graves are being dug outside of Toronto. Sick people are being boarded up in their homes. Watch out for a pack of wild dogs in the alley behind the Esso station. Snow plows are being used to move cars stacked up around the hospital. The Health Minister has the flu, or doesn’t have the flu. Tom Cruise has the flu, or doesn’t have the flu. Celine Dion has the flu, or doesn’t have the flu.
Most of these rumors weren’t true. Some of them, as we now know, were.

Table 3-1. Progress of epidemic in the province of Ontario and its estimated impact over its entire 10-week course.(54)

	Week 1	Week 2	Week 3	Week 4	Week 5
Clinically ill	190,305	317,175	475,763	542,369	482,106
Hospital admissions	19,031	31,718	47,576	54,237	48,211
Hospital acute care bed capacity	17,116	17,116	21,395	25,674	25,674
Requiring acute care beds	14,749	24,581	36,872	42,034	37,363
Bed demand as % capacity	86%	144%	172%	164%	146%
Requiring ICU beds	2,855	7,612	11,894	15,272	15,367
ICU bed capacity	1,510	1,510	1,888	1,888	1,888
ICU demand as % capacity	189%	504%	630%	809%	814%
Requiring ventilators	1,427	3,806	5,947	7,636	7,684
Ventilator bed capacity	1,096	1,096	1,370	1,370	1,370
Ventilator demand as % capacity	130%	347%	434%	557%	561%
Mortality (1.25% of clinically ill)	2,379	3,965	5,947	6,780	6,026
Mort. in hospital (70% of deaths)	1,665	2,775	4,163	4,746	4,218

	Week 6	Week 7	Week 8	Week 9	Week 10+
Clinically ill	475,763	317,175	190,305	120,527	60,264
Hospital admissions	47,576	31,718	19,031	12,053	6,026
Hospital acute care bed capacity	25,674	25,674	25,674	25,674	25,674
Requiring acute care beds	36,872	24,581	14,749	9,341	4,670
Bed demand as % capacity	144%	96%	57%	36%	18%
Requiring ICU beds	14,368	11,894	7,612	4,662	2,712
ICU bed capacity	1,888	1,888	1,888	1,888	1,888
ICU demand as % capacity	761%	630%	403%	247%	144%
Requiring ventilators	7,184	5,947	3,806	2,331	1,356
Ventilator bed capacity	1,370	1,370	1,370	1,370	1,370
Ventilator demand as % capacity	524%	434%	278%	170%	99%
Mortality (1.25% of clinically ill)	5,947	3,965	2,379	1,507	753
Mort. in hospital (70% of deaths)	4,163	2,775	1,665	1,055	527

    The fear grew as it became increasingly apparent to Canadians that government and private sector services they took for granted——police protection, fire protection, healthcare, electricity, water——could no longer be depended on. As police and fire departments became decimated with losses as high as 25 percent, they could no longer adequately respond to community needs. Fire in a bedroom? Get a bucket. The power goes out for an hour? Pray it comes back. Men breaking into your home? The cops aren’t coming. The phone goes dead for an hour? Deal with it. Daughter having an asthma attack? You had better have already stocked up on inhalers. After all, you were warned.
    So the origin of the Great Panic proved to be based on a simple math: With so much bad news, the rising tide of new flu cases and massive economic disruption, many people lost confidence in government, society and the future in general.(55)
    Whether they had the flu or not, the flu had them. It lived in their thoughts, plagued their dreams, dominated their lives.