Patrick Di Justo

The last great swine flu epidemic

"This virus will kill 1 million Americans," declared the U.S. in 1976. The panic then has a lot to teach us today.

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There is evidence there will be a major flu epidemic this coming fall. The indication is that we will see a return of the 1918 flu virus that is the most virulent form of the flu. In 1918 a half million Americans died. The projections are that this virus will kill one million Americans in 1976.

– F. David Matthews, secretary of health, education, and welfare (Feb., 1976)

In January 1976, 19-year old U.S. Army Private David Lewis, stationed at Fort Dix, joined his platoon on a 50-mile hike through the New Jersey snow. Lewis didn’t have to go; he was suffering from flu and had been confined to his quarters by his unit’s medical officer. Thirteen miles into the hike, Lewis collapsed and died a short time later of pneumonia caused by influenza. Because Lewis was young, generally healthy and should not have succumbed to the common flu, his death set off a cascade of uncertainty that confused the scientists, panicked the government and eventually embittered a public made distrustful of authority by Vietnam and Watergate.

This past Sunday, Homeland Security Secretary Janet Napolitano left open the possibility of a mass immunization program for the current outbreak of swine flu. If that happens, the Obama administration has a lot to learn from the debacle set in motion by Private Lewis’ ill-fated hike.

Lewis was a victim of swine flu, a form of influenza endemic to pig populations. Influenza is caused by a virus, a microorganism that is mostly dead and partially alive. The virus’ genetic code, held inside a protein sheath, consists of several helices of RNA. The virus injects its RNA into a healthy cell, which causes the cell to stop its usual work and make more copies of the virus. RNA genes mutate easily; for this reason, each new flu season brings a slightly different form of the disease into the population. Most year-to-year mutations bring little change to the virus, but for some still unknown reason, influenza seems to undergo a significant genetic change every ten years or so.

This major mutation results in a radically new strain of flu, one that races through a population because few people are immune to it. The dangerous influenza epidemics of 1938, 1947, 1957 (60,000 dead in the U.S.) and 1968 (the dreaded Hong Kong flu) fit this pattern. It was believed that swine flu, a particularly deadly form of the virus, had a 60-year mutation cycle that brought on worldwide pandemics, killing millions of people. Both the 10- and 60-year cycles were due to converge in the mid 1970s; Lewis’ death in 1976 was thought to be the first instance of a new, incredibly lethal type of flu.

Doctors from the Centers for Disease Control tested Private Lewis’ blood, and determined that his immune system had developed antibodies to a strain of flu similar to the Spanish influenza of 1918. That particular strain of swine flu produced the worst human pandemic of the 20th century: 1 billion sick in every country of the world, at least 22 million dead in the space of a few months. If Lewis had been exposed to something like the 1918 flu virus, the world could be in for an extensive and lethal outbreak. CDC doctors, charged with protecting the U.S. from epidemics, began to worry.

By the end of January, 155 soldiers at Fort Dix reported positive for swine flu antibodies. None of the soldiers’ families or co-workers, however, had been exposed to the virus; all of the reported swine flu cases had been limited to the soldiers in Private Lewis’ camp. The virus wasn’t spreading. For some reason this information did not mollify the doctors, and on Feb. 14, 1976, the CDC issued a notice to all U.S. hospitals to be on the lookout for any cases of swine flu.

By March, the normal end of flu season, worldwide cases of all types of flu had diminished, and not one case of swine flu had been reported outside of Fort Dix. For some reason this news did not placate the doctors either, and on March 13, 1976, the director of the CDC asked Congress for money to develop and test enough swine flu vaccine to immunize at least 80 percent of the population of the United States, believed to be the minimum needed to avoid an epidemic.

1976 was the year of the U.S. Bicentennial. 1976 was a presidential election year. 1976 was two years after Watergate caused Nixon’s resignation, and one year after the fall of Saigon. The U.S. government, both Republicans and Democrats, had never been held in such low esteem. Practically every elected official felt an overwhelming itch that patriotic year to do something to get the public thinking of them as good guys again. A swine flu pandemic was an opportunity on a plate. What better way to get into the good graces of the voters than to save them from a plague?

Between March 13 and March 24, the U.S. government dealt with the perceived flu emergency at fever pitch. The vaccine request went from the CDC to the secretary of HEW (Department of Health, Education and Welfare, the forerunner of today’s Department of Health and Human Services), and reached the president’s desk in less than a week. On March 24, the day after he lost the North Carolina primary to Ronald Reagan, President Gerald Ford welcomed the top virologists in the nation to a meeting in the White House and asked them if the nation was facing a swine flu epidemic. Would mass vaccinations be necessary? The doctors all said yes.

After the meeting, President Ford held a press conference with Jonas Salk and Albert Sabin, developers of the polio vaccine. The president heralded the impending flu plague and asked Congress for $135 million to investigate the development of a swine flu vaccine, with the goal of vaccinating the citizenry. This was probably the first time that most of the nation had heard of swine flu.

Congress, with few exceptions, raced to support the bill. Knowing the Republican president would not, could not veto a bill he requested, the Democratically controlled House attached $1.8 billion dollars in welfare and environmental spending to the flu bill. President Ford signed the bill on April 15, 1976, and incorrectly remarked to the press that the Fort Dix swine flu was identical to the deadly 1918 variety. He announced the immunization program would begin in October.

The scientists began to come to their senses. By July, they were pretty much agreed that a flu pandemic in 1976 would not lead to 1 million U.S. dead. The flu strain extracted from Private Lewis, they learned, was much less virulent that the 1918 strain, and modern medicine could handle an outbreak far better than the World War I doctors could. The World Health Organization ordered hospitals to keep a global lookout for swine flu, but it did not request mass immunization of the population.

But the U.S. government was unstoppable. Congress began to pressure the drug companies to work faster toward development of a swine flu vaccine. The drug companies insisted that proper vaccine development required years of experimentation and clinical trials, and they were reluctant to develop and distribute an untested drug. The drug companies suggested that they could work faster if they were given immunity from lawsuits in the event something went wrong with the vaccine. Congress refused. The issue of legal liability remained at an impasse until Aug. 2, 1976.

On that day, two members of the American Legion died of a strange respiratory disease they acquired at the Legion’s convention in Philadelphia. Congress collectively freaked. Panicky news reports out of Philadelphia hinted that the deaths were the beginning of the Great Swine Flu Epidemic of 1976. On Aug. 3, Congress agreed to completely indemnify the drug companies against any and all lawsuits they might incur as a result of the distribution of swine flu vaccine. The drug companies got to work.

On the same day, the CDC Disease Etiology Team sprang into action, and it had never performed better. On Aug. 5, the head of the CDC was able to testify before Congress and announce conclusively that the Legionnaires had died of a new disease, a type of pneumonia that was definitely not swine flu. When Congress was informed that the dreaded epidemic had not started, they canceled their indemnification agreement with the drug companies. The drug companies announced that they would immediately cease development of swine flu vaccines. They also began to hint that even if they were to be re-indemnified, they now wanted Congress to guarantee them reasonable profits from the development of the vaccines.

President Ford went on television that night and delivered a speech to the nation, telling Americans that Congress will be to blame for your deaths when the flu season begins in October. Congress caved in, and on Aug. 15, President Ford signed the National Influenza Immunization Program (NIIP). This set as a goal the immunization of at least 80 percent of the U.S. population, indemnified the drug companies and left vague the government’s power to limit the drug companies’ profit. The drug companies got to work.

By September, the swine flu scaffolding came crashing down. Pollsters reported that while 93 percent of the population had heard of swine flu and knew it could cause a million U.S. deaths, only 52 percent planned to get immunized. The press was claiming that Congress had not done a good job of educating the public. Congress members blamed the failure on the CDC. The CDC was busy looking into the deaths of the Legionnaires; while they were able to say that the Legionnaires had not died of swine flu, they were unable to pin down what exactly what had killed the men. The American Legion thought the whole thing was a Communist plot. Congressman John Murphy of Staten Island claimed the CDC was stalling on identifying the Legionnaire’s disease to panic people into fearing swine flu. Murphy demanded an investigation into the CDC and the indemnification deal made with the drug companies. The heroic miracle that was supposed to overhaul the government’s image was rendered futile before it had started.

On Oct. 1, 1976, the immunization program began. By Oct. 11, approximately 40 million people had received swine flu immunizations, mostly through the new compressed air vaccination guns. That evening, in Pittsburgh, came the first blow to the immunization program: Three senior citizens died soon after receiving their swine flu shots. The media outcry, linking the deaths to the immunizations without any proof, was so loud it drew an on-air rebuke from CBS news anchor Walter Cronkite, who warned his colleagues of the dangers of post hoc ergo propter hoc (“after this, therefore, because of this”) thinking. But it was too late. The government had long feared mass panic about swine flu — now they feared mass panic about the swine flu vaccinations.

The deaths in Pittsburgh, though proved not to be related to the vaccine, were a strong setback to the program. The death blow came a few weeks later when reports appeared of Guillain-Barré syndrome, a paralyzing neuromuscular disorder, among some people who had received swine flu immunizations. The public refused to trust a government-operated health program that killed old people and crippled young people; as a result, less than 33 percent of the population had been immunized by the end of 1976. The National Influenza Immunization Program was effectively halted on Dec. 16.

Gerald Ford’s attempt to gain credit for keeping America safe was busted. He lost the presidential election to Jimmy Carter that November. The 1976 to 1977 flu season was the most flu-free since records had been kept; a condition that was apparently unrelated to the vaccination program. The Great Swine Flu Epidemic of 1976 never took place.

Spaced out

Critics of manned spaceflight say the Columbia disaster means we must retreat from space. But what they're abandoning is the future.

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Spaced out

A little more than a year ago, I stood with about two dozen inner-city fifth graders underneath the great sphere at the Rose Center for Earth and Space in New York. I ceremoniously extracted a compact flash card from a digital camera. One child placed the memory card in a glass test tube. Another child weighed the tube and recorded the data. Yet another walked it over to a NASA employee standing on a raised platform, who gravely and graciously accepted the tube and put it in a large padded box. The memory card, loaded with pictures of the children’s goony, smiling faces, was going into outer space.

NASA had a program called the Space Experiment Module in which students all across the country, from K through 12, got a chance to place simple experiments aboard the space shuttle. These experiments mostly tested how various objects respond to spaceflight: One infamous SEM experiment determined how well cotton candy stood up to the radiation and weightlessness of outer space.

These kids were in my Saturday astrophysics class at the Rose Center. When I told them we had been selected for the SEM program, they refused to believe me. Fifth grade kids didn’t get to send stuff into outer space! I finally convinced them that it was for real, that they really could design experiments and put them on the shuttle. And the children lit up as if they were going into orbit themselves.

As did I. I’m a child of the Space Age. My first childhood memory is of the flight of Apollo 8. I collected astronaut GI Joes and watched every episode of “Star Trek,” and couldn’t wait for the day when I would go into space. I fought my grandfather, who was sure the moon landings were faked, and my uncle, who boasted that the Atlantean race had been there before. For me, the question of whether the benefits from manned spaceflight outweighed the risks, or the expense, was hardly worth bothering over.

But as the years went on and we got further from that dream, I began to doubt, and then ultimately to oppose with righteous fervor, the entire concept of manned spaceflight. If we wanted to discover life on Mars, we didn’t need people in space to do it. And if I wasn’t going, I childishly didn’t want anyone to go.

After the Columbia disaster, the debate over whether there is a point to subsidizing manned spaceflight has been opened up again, with a vengeance. I’ve found, perhaps because of my students, that I’ve returned to my youthful passions. And I’ve come to feel that the value of manned spaceflight isn’t found at the bottom of a balance statement or on a spreadsheet.

The modern fascination with space travel dates back to the early 1600s, when the invention of the telescope showed mountains and plains on the moon, and revealed the starlike planets to be worlds in their own right. The 17th century was a great age of exploration, and it was only natural to want to extend our discoveries beyond Earth. Lacking the means to do so, scientists and popular writers visited the other planets through the printed page, in what would come to be known as the science fiction novel.

In the 1880s, a Russian engineer, Konstantin Tsiolkovsky, published designs for the first practical interplanetary spacecraft. Eighty years later, Soviet cosmonaut Yuri Gagarin became the first person to orbit Earth, going into space in what was essentially Tsiolkovsky’s rocket. This Cold War coup, followed a few weeks later by the Bay of Pigs embarrassment, practically forced President Kennedy into declaring a race to the moon to save face. The future, that great undiscovered country, was going to be explored and understood by taciturn men in white suits and Snoopy hats, going in peace and taking along all mankind.

But once we reached the moon in 1969, mankind said thanks and lost interest. When we beat the Russians, we killed our only coherent, easily understood justification for having people in space. The public increasingly became aware of problems on Earth that needed fixing, and that fomented a backlash against space exploration from which NASA has never fully recovered. If they can put a man on the moon, the saying went, why can’t they [cure cancer, end racism, clean this goddamn snow off my driveway]? Others were more direct: “I just can’t for the life of me see voting for monies to find out whether or not there is some microbe on Mars, when in fact I know there are rats in Harlem apartments,” said then Rep. Ed Koch of New York in 1971.

NASA’s darkest days, as far as manned spaceflight is concerned, were probably the six years from 1974 to 1980. There was only one manned mission in that time, a single Apollo capsule launched into low Earth orbit to dock with a Soviet Soyuz. It was a propaganda display of the new era of détente between the superpowers, but the congratulatory handshakes with our old enemies might just as well have been a way of saying thanks, we couldn’t have done it without you.

The development of the space shuttle in 1981 didn’t bring back Apollo-era public support for manned spaceflight. The shuttle was designed to fulfill NASA’s grandiose post-Apollo plans for the conquest of the solar system. It would assist in the creation of a moon base, a 100-man space station, and various trips to Mars. When those plans died, all reason for the shuttle died with them. The unmanned Viking mission to Mars in 1976, and the spectacular pictures of Jupiter and Saturn sent back by the twin Voyager probes in 1980, showed that humans were unnecessary cargo when it came to exploring the planets. The first few shuttle missions were greeted with interest, but soon most of the public didn’t even know when a flight was in orbit. NASA was to spend more than a decade trying to find a purpose for its new toy — thus giving ammunition to those who felt that billions of dollars were being wasted.

When space shuttle Challenger disintegrated during launch in January 1986, the naysayers came out again, and at the time I was one of them. Not only is space travel too dangerous for humans, we said, it’s also too expensive. In these days of limited space budgets, NASA spends far too much money on the shuttle. Space exploration could be done far more efficiently (not to mention safely) with unmanned robots, we said. The endless development of the space station Freedom, which spent its entire budget without launching a stick of hardware into space, only seemed to prove the point. By the end of the 1980s, it seemed that the shuttle’s only supporters were the people whose jobs depended on it and the politicians who were afraid to kill it completely.

But on Sept. 2, 1993, U.S. Vice President Al Gore and Russian Prime Minister Viktor Chernomyrdin signed an agreement for the two nations to cooperate in space. The international partnership seemed to breathe new life into the concept of human spaceflight. Suddenly the shuttle had something to do! America’s aborted space station was resurrected and renamed the International Space Station; it would be launched into an orbit accessible to both Cape Canaveral and Baikonur. Cosmonauts would fly on the shuttle and astronauts would fly to Mir, working under the control of each other’s space agencies, collaborating jointly on everything. And with a permanent human presence in space came a new category on the shuttle’s astronaut manifest: who was going up, and who was coming down.

By January 2002, it looked as if manned spaceflight had a rosy future after all. Shuttle missions to complete ISS and repair the Hubble Space Telescope had been planned out to 2006. Next-generation propulsion systems that could land humans on Mars were in the advanced planning stages. And NASA was getting ready to launch Columbia, its oldest shuttle, on an all-science mission, one that would contain experiments sent in by schoolchildren from all over the country.

It took some work to get the kids to design realistic experiments. A few kids wanted to send up personal items, like locks of their hair or pictures of their family, as souvenirs. One student wanted to pack the test tubes with sand and sell the individual grains on eBay.

We eventually came up with five ideas. Two experiments tested whether there was more ultraviolet light in space than on Earth. One experiment determined if photographic film was sensitive to space radiation. One experiment was designed to see if a tube full of Central Park air smelled any different after it had been in space. And the final experiment tested if a digital camera’s memory card would still contain pictures after being exposed to space radiation for two weeks. Of course, we already knew the answers to most of these questions, but that was OK; the official reason for the project was to help the students develop scientific thinking. The real lesson was to teach the kids that knowledge and curiosity could take them literally anywhere. It was a lesson I once knew but had forgotten.

What would become the last flight of Columbia, mission STS-107, was originally scheduled for July 2002. It finally launched on Jan. 16, 2003, almost a year after we wrapped the experiments. The mission ended last Saturday with a streak of light across the Texas sky.

The kids and I never got the chance to meet any of the astronauts on “our” flight, so I don’t know if their deaths will be anything more than abstract losses to these students, now in sixth grade. I think they’ll be most upset at the fact that their experiments won’t be coming back. I remember the students’ initial suspicion that the project was a sham, and I’m sure some of the kids will feel angry for letting themselves believe. Outwardly they’ll be little gangsta tough guys, pretending that they don’t care. Inside, though, some of these children will feel that their only chance to touch the stars has been forever taken away. Part of me also feels that way.

Imagining what might have been gives us some perspective. The Arthur C. Clarke and Stanley Kubrick timeline would have given us giant rotating space stations, moon bases, and manned missions to Jupiter two years ago. Early NASA timelines would have had us on Mars 17 years ago. Even a more modest timeline would have had ISS finished already.

Yet other timelines would have had us not going into space at all, or going for a little while and then stopping. Apathy, shortsightedness, isolationism or a host of other problems could have kept us out of space for good. As modest as our current program is, it is literally better than nothing.

Now the drums are beating again, calling once more for a withdrawal from manned spaceflight. The same old arguments — money, safety, other more pressing problems — will be dredged up. A new area of opposition to manned spaceflight will probably be centered on the fear of terrorism: Spending money in space, instead of on homeland security, will lead to more dead astronauts and more dead citizens!

But like all the other economic reasons to neglect space travel, this is a false dichotomy. We have the money to find Martian microbes and eliminate Harlem rats, if we really want to do both. If there were to be a march on Washington to redirect NASA’s entire budget to find a cure for AIDS or cancer, I would be at the head of the line. But that bargain will never take place; money diverted from the space budget will never be spent en masse to rectify anyone’s favorite cause. There’s no logical reason we can’t achieve a balance, spending an appropriate amount of money on homeland security, on eliminating AIDS, on unemployment insurance, and on manned spaceflight. The Senate is discussing this week the question of NASA’s future, and while there will no doubt be a shakeup at the agency, no draconian cuts are planned. The shuttle and the International Space Station will remain part of NASA’s mission.

There are some who ask what are the here-and-now, bread-and-butter reasons for building a space station. The answer is that there are none. Or at least none that could be achieved only by building a space station. The Apollo program didn’t give us Tang or Velcro, but at least it paved the way for cordless tools, scratch-resistant eyeglasses and all-weather radial tires. We won’t even get that from ISS. There is talk that ultra-pure drugs can be produced in orbit, and they can, but in a practical sense it’s just talk. New alloys, crystals grown in microgravity, even orbital nanotechnology will make for great experiments, but not great spinoff products anytime soon.

This is a problem because people continually try to compare our current system of human space exploration with the voyages of discovery made in the 1500s. They couldn’t be more wrong. Those voyages were commercial expeditions, intended to produce stupendous profits by obtaining tradable goods for a small number of shareholders. That’s not going to happen in space for some time to come. The only way manned space will show a profit for the foreseeable future is by taking multibillionaires and boy-band singers up for $10 million joy rides.

Contemporary manned spaceflight is more comparable to the sea voyages of Captain Cook, or of Charles Darwin’s Beagle, at the height of the British Empire. Those expeditions existed solely to gather scientific data from all over the world. Cook and others collected information on geology, geography, astronomy, botany, oceanography, magnetism; nearly every branch of science was explored. If their researches eventually showed a profit, that was icing on the cake. It’s no accident that the shuttles Endeavour and Discovery are named after Captain Cook’s ships. As Cook taught us how to travel over the Earth, and eventually lost his life in doing so, the astronauts and cosmonauts are teaching us how to travel through space.

Regarding safety, here’s a news flash: Space is dangerous. Inherently. While we will do everything we can to minimize the danger, traveling in space will never be as secure as sitting in your office. But that’s all right. We know it’s not safe, and some people are prepared to take that risk. We didn’t stop flying in space when three American astronauts died in a launch-pad fire in January 1967. We didn’t stop when a Soviet cosmonaut, Vladimir Mikhailovich Komarov, died a few months later as his spacecraft tumbled out of control during landing. We didn’t stop in 1971 when three more cosmonauts died during reentry. We didn’t give up after Challenger was destroyed. Throughout human history, we’ve never been content with just looking at far-off hills; there’s always someone in the village who wants to know what’s on the other side.

Soon after Columbia broke apart on Saturday, the following message appeared in my e-mail. It’s a quote from “Star Trek: The Next Generation,” and it’s been making the rounds. Its message is not to minimize the death of seven astronauts, but to remind us of what the point of human space exploration really is:

“If you can’t take a little bloody nose, maybe you ought to go home and crawl under your bed. It’s not safe out here. It’s wondrous; with treasures to satiate desires both subtle and gross. But it’s not for the timid.”

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