Inside the Fight Against a Flu Pandemic

As they have for most of the past 87 years, hundreds of children from across the Eastern seaboard arrived in June at Camp Modin in Belgrade, Maine, carrying flip-flops, sleeping bags and swimsuits. But they also carried something new. First there was one fever, then six, then nine campers in a single day. By the end of the first full week, dozens of kids were sleeping on state-issued cots in a specially quarantined cabin, waiting out a pandemic flu virus that is barnstorming its way across the globe. Camp Modin was not alone; so far this summer, at least 80 camps in 40 states, including a full quarter of Maine's residential summer camps, have reportedly been hit by the bug known worldwide as H1N1. U.S. health officials were struck by a trend they regarded as unusual and troubling: a flu outbreak in the middle of summer.

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Just a few weeks after the Modin quarantine, senior officials from across the government gathered in the basement of the West Wing to begin planning for the siege to come. On the flat-screen televisions embedded in the soundproof walls, a PowerPoint slide flashed the human toll of previous epidemic flus: more than 600,000 Americans died in the 1918 pandemic, 70,000 "excess" deaths resulted from the Asian flu in 1957, and there were 34,000 deaths after the Hong Kong flu hit in 1968. Next to the 2009-10 H1N1 pandemic, the screens showed nothing but a series of question marks. The punctuation was designed to make a larger point. As a senior official in charge of responding to the crisis later told TIME, "You are going to see a spike in deaths." (See pictures of the swine flu in Mexico.)

No one knows for sure what that spike will look like or how it will compare with the roughly 36,000 Americans who die each year from seasonal flu. But ever since the first case of H1N1 flu was reported in Mexico last March, the Obama Administration has been girding for a difficult fall and winter, which may see millions getting sick, overwhelmed hospitals, rolling closures of schools, disruption of workplaces, canceled public events and a death rate no one can predict. "We just don't know the magnitude of this," says Secretary of Education Arne Duncan, who has been working throughout the summer to prepare schools. "The unknown — that's what you worry about."

The good news is that H1N1 is not, so far, a particularly severe disease for those who are healthy. Through July, 353 Americans were confirmed to have died from the new flu out of an estimated 1 million infected. With the exception of certain populations — including pregnant women, children with chronic diseases and people with respiratory ailments — H1N1 tends to be no worse than the seasonal flu. A few days in bed and lots of liquids, and most patients get better. The bad news is that H1N1 is highly contagious and, unlike many other flus, is particularly hard on children and teens.

While H1N1 proved to be a manageable bug during the spring, U.S. officials are taking no chances as autumn, the traditional flu season, approaches. One pessimistic model from the Centers for Disease Control and Prevention (CDC) predicts that 40% of the nation could be struck — roughly 140 million people — with perhaps a six-figure death toll if a vaccination campaign is not successfully implemented. "To a lot of people, the flu went away," worries Kathleen Sebelius, Secretary of Health and Human Services, who received her first Situation Room flu briefing minutes after taking her oath in April. "Nothing could be further from the truth."

The Mobilization
Sebelius says the most accurate modeling for the current virus is likely to be found in the 1957 flu epidemic. Like H1N1, that flu began early in the year on foreign soil and was relatively quiet in the summer. Once school reconvened, however, it surged. As the disease peaked in October — between the launch of Sputnik and the release of the movie Jailhouse Rock — 43% of Manhattan students and 11% of New York City teachers reported absent from school in a single day. By the time it dissipated, about 1 in 4 Americans had taken ill from the disease, though the vast majority recovered without any lasting harm, according to a study by the Center for Biosecurity in Baltimore.

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