Pandemic

"In the winter of 1918–1919 this mutated influenza virus killed twenty million people. Which in today's terms is the equivalent of eighty million dead in less than six months"

Someone in the crowd oohed

"Well put." Haldane nodded solemnly. "And we're not talking about twenty million ancient nursing home residents or mutilated war vets aching for deliverance. In fact, the opposite. For reasons unknown, this virus selectively killed young healthy adults. People would go to bed at night and not wake up the next morning… or any morning." Haldane eyed a student in the second row who played on the varsity baseball team. "Not even pro athletes were safe. The 1919 Stanley Cup had to be halted because two of the Montreal Maroons dropped dead in the middle of the series.

"And if you think all hell broke loose because of primitive infection control and treatment measures, you would be wrong again. Granted, public health was limited in 1919, but we wouldn't fare much better today facing such an outbreak. We still have no specific treatment. And with every single person in the world connected by three or less commercial flights, it might spread even faster.

"It was probably only because of the draconian public health measures-people were quarantined in jails and some countries made it illegal to shake hands — that the epidemic was controlled at all.

"But the strangest part of the whole story?" Haldane allowed himself a theatrical pause. "There was nothing particularly unique about the Spanish Flu. Each winter the latest incarnation of influenza rolls around from Bangkok or Hong Kong or Melbourne or some other exotic locale I can't afford to visit." No one laughed. "It opens up beds in nursing homes, keeps temp agencies busy, and makes life an achy hell for those of us unlucky enough to stand in its path. But it does not decimate the population." He scanned the audience, satisfied he held their rapt attention. "The reason influenza only kills the old and the infirm is, flu shot or not, the virus is old news to our immune system. It's just a slightly modified — a protein here, an organic ring there — version of an antigen our immune system has seen before. So our bodies can mount a strong defense."

Haldane thumbed at the screen. "Not so with the Spanish Flu. It represented a brand-new genre of the virus." He shrugged. "But that's what viruses excel at, right? They mutate. In fact, up until 1919 every forty years, like clockwork. the latest version of a new and devastating influenza virus surfaced.

"So, the weirdest thing about the Spanish Flu is that we haven't seen a similar pandemic in over eighty years." He shook his head. "Not to put a damper on your bright futures, Doctors, but the killer flu is way overdue!"

* * *

Noah Haldane chuckled to himself on the drive back to his office. Sure he'd offered up a little ham with his lecture, but he believed it critical that his students — and all future physicians — hear the message: they were the front line against the next wave of epidemic, which almost certainly would be viral. It was vital that they recognized the signs early. And judging from the cacophony of questions after his lecture, hear him they did.

In those dark days of spring 2003, when he'd spent his time shuttling between Hong Kong, Hanoi, and Singapore, he wasn't as confident that SARS would just be a flash in the pan. None of them at the World Health Organization were.

Haldane hadn't exaggerated when he told the students that he'd been touched by the destructive power of SARS. It had claimed the life of a close friend and colleague, Dr. Franco Bertulli, in a Singapore Intensive Care Unit. Wearing full biohazard gear, Haldane had sat at Bertulli's bedside until the end and watched helplessly as his friend suffocated in his own secretions. Nothing in all his medical, virology, or epidemiological training prepared him for that. And the vision still visited him regularly in the form of a recurring nightmare.

But over a year had passed since the last travel advisory was issued. Haldane was home, and reveling in the relative quiet of the infectious diseases world. He had time to catch up on his research and clinical work. Best of all he had time to reconnect with his three-year-old daughter Chloe. Enough time even to take a stab at resuscitating his crumbling marriage.

Lost in plans for a family getaway for the upcoming weekend, Haldane breezed through the door of his research office in Georgetown. "Karen, hi," he said as he dropped off a cup of coffee on his receptionist's desk and then strode past her into his office.

When Haldane ignored his receptionist's hailing, she jumped up and followed him into the office. At twenty-seven, Karen Jackson had taken the job as Haldane's secretary so she could entrench herself in the academic milieu while she worked her way through graduate school. An African American full-figured beauty, she was bright, able, and defiant to a fault.